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Urinary Incontinence in Women

Topic Overview

The urinary system and its location in the body

What is urinary incontinence?

Urinary incontinence is the accidental release of urine. It can happen when you cough, laugh, sneeze, or jog. Or you may have a sudden need to go to the bathroom but can't get there in time. Bladder control problems are very common, especially among older adults. They usually don't cause major health problems, but they can be embarrassing.

Incontinence can be a short-term problem caused by a urinary tract infection , a medicine, or constipation. It gets better when you treat the problem that is causing it. But this topic focuses on ongoing urinary incontinence.

There are two main kinds of urinary incontinence. Some women—especially older women—have both.

  • Stress incontinence occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladder . It is the most common type of bladder control problem in women.
  • Urge incontinence happens when you have a strong need to urinate but can't reach the toilet in time. This can happen even when your bladder is holding only a small amount of urine. Some women may have no warning before they accidentally leak urine. Other women may leak urine when they drink water or when they hear or touch running water. Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine.

What causes urinary incontinence?

Bladder control problems may be caused by:

  • Weak muscles in the lower urinary tract .
  • Problems or damage either in the urinary tract or in the nerves that control urination.

Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch the pelvic floor muscles . When these muscles can't support your bladder properly, the bladder drops down and pushes against the vagina. You can't tighten the muscles that close off the urethra . So urine may leak because of the extra pressure on the bladder when you cough, sneeze, laugh, exercise, or do other activities.

Urge incontinence is caused by an overactive bladder muscle that pushes urine out of the bladder. It may be caused by irritation of the bladder, emotional stress, or brain conditions such as Parkinson's disease or stroke. Many times doctors don't know what causes it.

What are the symptoms?

The main symptom is the accidental release of urine.

  • If you have stress incontinence, you may leak a small to medium amount of urine when you cough, sneeze, laugh, exercise, or do similar things.
  • If you have urge incontinence, you may feel a sudden urge to urinate and the need to urinate often. With this type of bladder control problem, you may leak a larger amount of urine that can soak your clothes or run down your legs.
  • If you have mixed incontinence, you may have symptoms of both problems.

How is urinary incontinence diagnosed?

Your doctor will ask about what and how much you drink. He or she will also ask how often and how much you urinate and leak. It may help to keep track of these things using a bladder diary for 3 or 4 days before you see your doctor.

Your doctor will examine you and may do some simple tests to look for the cause of your bladder control problem. If your doctor thinks it may be caused by more than one problem, you will likely have more tests.

How is it treated?

Treatments are different for each person. They depend on the type of incontinence you have and how much it affects your life. After your doctor knows what has caused the incontinence, your treatment may include exercises, bladder training, medicines, a pessary, or a combination of these. Some women may need surgery.

There are also some things you can do at home. In many cases, these lifestyle changes can be enough to control incontinence.

  • Cut back on caffeine drinks, such as coffee and tea. Also cut back on fizzy drinks like soda pop. And don't drink more than one alcohol drink a day.
  • Eat foods high in fiber to help avoid constipation.
  • Don't smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
  • Stay at a healthy weight.
  • Try simple pelvic-floor exercises like Kegel exercises .
  • Go to the bathroom at several set times each day, and wear clothes that you can remove easily. Make your path to the bathroom as clear and quick as you can.
  • Keep track of your symptoms and any leaking of urine with a bladder diary. This can help you and your doctor find the best treatment for you.

If you have symptoms of urinary incontinence, don't be embarrassed to tell your doctor. Most people can be helped or cured.

How can you prevent urinary incontinence?

Strengthening your pelvic muscles with Kegel exercises may lower your risk for incontinence.

If you smoke, try to quit. Quitting may make you cough less, which may help with incontinence.

Frequently Asked Questions

Learning about urinary incontinence:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with urinary incontinence:

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Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Stress Incontinence in Women: Should I Have Surgery?

Cause

Stress incontinence

Stress incontinence is caused by conditions that stretch the pelvic floor muscles , such as:

  • Childbirth.
  • Weight gain.

When these muscles can't support your bladder well, the bladder drops down and pushes against the vagina . Then you can't tighten the muscles that usually close off the urethra . So urine may leak because of the extra pressure on the bladder when you cough, sneeze, laugh, exercise, or do other activities.

This is the most common type of urinary incontinence in women.

A chronic cough from smoking can make stress incontinence worse.

Urge incontinence

Urge incontinence is caused when the bladder muscle involuntarily contracts and pushes urine out of the bladder. Many times doctors don't know what causes this. But sometimes the cause is:

  • Irritation of the bladder.
  • Emotional stress.
  • Brain conditions such as Parkinson's disease or stroke.

Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine. For more information, see the topic Overactive Bladder.

Other types of incontinence

Less common types of urinary incontinence have other causes. These types include:

Symptoms

The main symptom of urinary incontinence is a problem controlling urination.

  • Symptoms of stress incontinence:
    • Involuntary release of urine, especially when you cough, sneeze, or laugh
    • Leaking a small to moderate amount of urine
  • Symptoms of urge incontinence:
    • Frequent and sudden uncontrollable need to urinate
    • May leak a moderate to large amount of urine, although a small amount is possible

It is common for a woman to have symptoms of both types of incontinence. This is called mixed incontinence.

What Happens

Urinary incontinence usually starts gradually and slowly becomes worse. As it gets worse, a woman may:

  • Avoid going out in public because of embarrassment.
  • Become less active.
  • Have physical problems caused by frequent urine contact. These problems may include irritation of the groin area and more frequent urinary tract infections .

Treating the cause of incontinence often gets rid of or controls these problems.

Some bladder problems are temporary. For example, you may have a urinary tract infection that causes incontinence, but the problem goes away after the infection is cured.

What Increases Your Risk

Sometimes several things combine to cause urinary incontinence. For example, a woman may have had multiple childbirths, be older, and have a severe cough because of chronic bronchitis or smoking. All of these might contribute to her incontinence problem.

Physical conditions that make urinary incontinence more likely include:

  • Pregnancy and vaginal delivery.
  • Having had a hysterectomy.
  • Obesity or being overweight.
  • Older age.
  • Bladder stones .
  • Structural abnormalities of the urinary tract.
  • Blockage of the bladder.
  • Chronic bladder infections .

Diseases and conditions that may cause urinary incontinence include:

  • Chronic cough due to smoking or bronchitis.
  • Pelvic organ prolapse.
  • Diabetes.
  • Parkinson's disease.
  • Alzheimer's disease.
  • Multiple sclerosis.
  • Bladder cancer.
  • Stroke.
  • Spinal cord injury.

Medicines and foods that may make urinary incontinence worse include:

  • Caffeinated and carbonated drinks, such as coffee, tea, and soda pop.
  • Alcohol drinks.
  • Prescription medicines that increase urine production (such as diuretics) or relax the bladder (such as anticholinergics and antidepressants).
  • Smoking.

When To Call a Doctor

Call your doctor if:

  • You have urinary incontinence that begins suddenly. This is called acute incontinence. It is often caused by urinary tract problems or medicines and can be easily corrected.
  • The involuntary release of urine is enough of a problem that you need to wear an absorbent pad, or if incontinence interferes with your life in any way.

Don't be embarrassed to discuss urinary incontinence with your doctor. Urinary incontinence is not an inevitable result of aging. Most women with incontinence can be helped or cured.

Watchful waiting

If you have urinary incontinence that develops slowly, you may be able to control the problem yourself. If home treatment is not effective, or if incontinence interferes with your lifestyle, ask your doctor about other treatments.

Who to see

Health professionals who can diagnose and treat urinary incontinence include:

Your health professional may want you to see a doctor who specializes in problems of the urinary tract ( urologist ) or who specializes in treating older people ( geriatrician ).

If you need surgery, it is important to find a surgeon who is experienced in the types of surgical procedures used to treat incontinence.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

To diagnose the cause of your urinary incontinence, your doctor will ask about your medical history and do a physical exam. It may be easier for you to answer questions if you keep a bladder diary (What is a PDF document?) for 3 or 4 days before you see your doctor.

To check for stress incontinence, your doctor may ask you to cough while you are standing.

Your doctor may also order these tests:

  • Bladder stress test and Bonney test
  • Pad test, which can help show how much urine is leaking. You are given an absorbent pad that has been weighed. You wear the pad until urine leaks, and then you return the pad to be weighed again. The increased weight of the pad gives an estimate of how much urine leaked.
  • Urinalysis and urine culture

Urodynamic testing

Urodynamic testing is expensive. It is typically done only if surgery is being considered or if treatment has not worked for you and you need to know more about the cause. It provides a more advanced way to check bladder function.

The actual tests done in urodynamic testing often vary. They may include:

  • Cystometry, a series of tests to measure bladder pressure at different levels of fullness.
  • Postvoid residual (PVR) measurements, which measure the amount of urine that stays in your bladder after you urinate.
  • X-rays or ultrasound . These are used to examine changes in the position of the bladder and urethra during urination, coughing, or straining.

If the cause of incontinence is not identified by the above tests, more extensive tests may be needed.

Treatment Overview

Urinary incontinence isn't an inevitable result of aging. Most women who have it can be helped or cured.

The best treatment depends on the cause of your incontinence and your personal preferences. Treatments include:

  • Behavioral training, such as bladder training and timed urination. For more information, see Other Treatment.
  • Lifestyle changes and pelvic floor (Kegel) exercises. For more information, see Home Treatment.
  • Medicines. For more information, see Medications.
  • Medical devices. For more information, see Other Treatment.
  • Surgery. For more information, see Surgery.

Behavioral training, exercises and lifestyle changes, and medicines are usually tried first. If the problem does not get better, your doctor may try another treatment or do more tests.

When there is more than one cause for incontinence, the most significant cause is treated first, followed by treatment for the secondary cause, if needed.

Prevention

You may reduce your chances for urinary incontinence by:

Home Treatment

If you have urinary incontinence, you can take some steps on your own that may stop or reduce the problem.

  • Set a schedule of urinating every 2 to 4 hours, regardless of whether you feel the need.
  • Talk with your doctor about all prescription and nonprescription medicines you take. Find out if any of them may be making your incontinence worse.
  • Use a bladder diary (What is a PDF document?) to keep track of your symptoms and any leaking of urine. Your diary can help you and your doctor find the best treatment for you.
  • If you have trouble reaching the bathroom before you urinate, try making a clearer, quicker path to the bathroom and wearing clothes that are easily removed (such as those with elastic waistbands or Velcro closures). Or keep a bedpan close to your bed or chair.
  • Wear a tampon while doing activities such as jogging or dancing to put a little pressure on your urethra and to temporarily slow or stop leakage.
  • Avoid drinking too much or too little fluid. Too much can increase the need to urinate and increase incontinence. Too little can cause dehydration.

Exercises

Pelvic floor (Kegel) exercises can help women who have any type of urinary incontinence. 1 These exercises are especially useful for stress incontinence. But they may also help urge incontinence.

Lifestyle changes

Losing weight often helps stress incontinence. Remember that effective weight-loss programs depend on a combination of diet and exercise.

To learn more, see:

Sometimes making lifestyle changes can help with urge incontinence. Try to identify any foods that might irritate your bladder—including citrus fruits, chocolate, tomatoes, vinegars, dairy products, aspartame, and spicy foods—and cut back on them. Also, avoid alcohol and caffeine.

If you smoke, try to quit. This may reduce coughing, which may reduce your problem with incontinence. For more information, see the topic Quitting Smoking.

Take steps to avoid constipation:

  • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
  • Drink plenty of fluids, enough so that your urine is light yellow or clear like water.
  • Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.
  • Take a fiber supplement, such as Citrucel or Metamucil, every day if needed. Start with a small dose and very slowly increase the dose over a month or more.
  • Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and don't strain when having a bowel movement.

Medications

Urinary incontinence may be treated with medicines. But in many cases, treatment with behavioral methods (bladder training, timed urination) and Kegel exercises are tried before medicines. These treatments, when combined with medicine, may help some women more than either treatment alone.

Medicine choices

For stress incontinence:
For urge incontinence:
  • Anticholinergic medicines, such as oxybutynin (for example, Oxytrol) and tolterodine (Detrol)
  • Imipramine (for example, Tofranil), often used in combination with an anticholinergic medicine
  • Estrogen cream or gel

Botulinum toxin (Botox) may be used in people with nervous system diseases or problems (such as multiple sclerosis or a spinal cord injury) to stop bladder contractions that cause severe urge incontinence. But Botox will only be considered if other treatments haven't worked. Botox can cause serious side effects, including not being able to urinate at all.

Surgery

There are several different kinds of surgeries to correct stress incontinence , which occurs when weakened pelvic floor muscles allow the bladder neck and urethra to drop. These surgeries seek to lift the urethra, the bladder, or both into the normal position. This makes sneezing, coughing, and laughing less likely to make urine leak from the bladder.

Surgery works to cure stress incontinence better than any other treatment. If other treatments (like pelvic floor muscle exercises) haven't worked to control your incontinence, surgery may be your best option. What kind of surgery you have depends on your preference, your health, and your doctor's experience.

Surgery is done much less often for urge incontinence, and the results are not as good.

Click here to view a Decision Point. Stress Incontinence in Women: Should I Have Surgery?

Surgery choices

Other Treatment

Other types of treatment for urinary incontinence include:

  • Behavioral methods . These are often the first thing to try. They often work well. They include:
    • Bladder training (also called bladder retraining). This is used to treat urge incontinence. With bladder training, you slowly increase how long you can wait before having to urinate by trying to delay urination after you get the urge to go.
    • Biofeedback. This is a technique for learning to control a body function that is not normally under conscious control. It is usually used to teach pelvic floor muscle exercises.
    • Pelvic floor muscle exercises (Kegels). Kegel exercises can help strengthen some of the muscles that control the flow of urine. These exercises are used to treat urge or stress incontinence.
  • Acupuncture . There isn't a lot of evidence for how well acupuncture works for urinary incontinence. In one study, comparing bladder-specific acupuncture to sham acupuncture , both groups had less incontinence. But the group with bladder-specific acupuncture didn't have as many episodes of urgency. 2
  • Mechanical devices , such as a pessary.
  • Absorbent products , such as diapers.

Before trying behavioral methods or exercise for urinary incontinence, ask your doctor the following questions:

  • Is behavioral or exercise therapy alone likely to restore bladder control? Mild to moderate cases of common types of incontinence can be cured or greatly improved by these methods.
  • How long should I try behavioral or exercise techniques before I consider surgery or other treatment methods? Techniques like Kegel exercises don't limit future treatment options (and they may even improve the odds of success for other treatments). So it is best to set a length of time after which the improvement can be evaluated.
  • Can I use exercises or behavioral methods along with medicine if medicine treatment is recommended? It may be possible to take medicine for a shorter time or to reduce the amount of medicines used if other methods of treatment are combined with medicine.

Other Places To Get Help

Organizations

American Geriatrics Society: The AGS Foundation for Health in Aging
40 Fulton Street
18th Floor
New York, NY  10038
Phone: 1-800-563-4916
Phone: (212) 308-1414
Email: StaffHIA@americangeriatrics.org
Web Address: www.healthinaging.org
 

The AGS Foundation for Health in Aging was started by the American Geriatrics Society (AGS). The foundation works on behalf of older adults in the areas of wellness and preventive care, self-responsibility and independence, and connections to family and community.

This website has stories about healthy aging, information on caring for elders at home, and tips on winter safety, preparing for emergencies, and meeting the challenges of healthy aging. The site also has links to many other Internet resources on aging.


American Urogynecologic Society
2025 M Street NW
Suite 800
Washington, DC  20036
Phone: (202) 367-1167
Fax: (202) 367-2167
Email: info@augs.org
Web Address: www.augs.org
 

The American Urogynecologic Society (AUGS) is the premier society dedicated to research and education in urogynecology and in the detection, prevention, and treatment of female lower urinary tract disorders and pelvic floor disorders.


AUA Foundation: The Official Foundation of the American Urological Association
1000 Corporate Boulevard
Linthicum, MD  21090
Phone: 1-800-828-7866
Phone: (410) 689-3700
Fax: (410) 689-3998
Email: auafoundation@auafoundation.org
Web Address: www.urologyhealth.org
 

UrologyHealth.org is a website written by urologists for patients. Visitors can find specific topics by using the "search" option.

The website provides information about adult and pediatric urologic topics, including kidney, bladder, and prostate conditions. You can find a urologist, sign up for a free quarterly newsletter, or click on the Urology A–Z page to find materials about urologic problems.


National Association for Continence (NAFC)
P.O. Box 1019
Charleston, SC  29402-1019
Phone: 1-800-BLADDER (1-800-252-3337)
Phone: (843) 377-0900
Fax: (843) 377-0905
Web Address: www.nafc.org
 

NAFC is a nonprofit national organization with a mission of consumer advocacy, education of the public, and information dissemination through collaboration and networking for the benefit of those with urinary incontinence. NAFC's booklet "Your Personal Guide to Bladder Health" can be ordered on the NAFC website.


National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD  20892-3580
Phone: 1-800-891-5390
TDD: 1-866-569-1162
Fax: (703) 738-4929
Email: nkudic@info.niddk.nih.gov
Web Address: www.kidney.niddk.nih.gov
 

The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) provides information about diseases of the kidneys and urologic system to people with these problems and to their families, to health professionals, and to the public. NKUDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient groups and government agencies to coordinate resources about kidney and urologic diseases.

NKUDIC, a federal agency, is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services.


National Kidney Foundation
30 East 33rd Street
New York, NY  10016
Phone: 1-800-622-9010
Phone: (212) 889-2210
Fax: (212) 689-9261
Web Address: www.kidney.org
 

The National Kidney Foundation works to prevent kidney and urinary tract diseases and help people affected by these conditions. Its website has a lot of information about adult and child conditions. The site has interactive tools, donor information, recipes for kidney disease patients, and message boards for many kidney topics. Free materials, such as brochures and newsletters, are available.


References

Citations

  1. Dumoulin C, Hay-Smith J (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews (1).
  2. Emmons SL, Otto L (2005). Acupuncture for overactive bladder. Obstetrics and Gynecology, 106(1): 138–143.

Other Works Consulted

  • Barber MD, et al. (2008). Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence. Obstetrics and Gynecology, 111(3): 611–621.
  • Hartmann KE, et al. (2009). Treatment of Overactive Bladder in Women. Evidence Report/Technology Assessment No. 187 (AHRQ Publication No. 09-E017). Available online: http://www.ahrq.gov/clinic/tp/bladdertp.htm.
  • Kirchin V, et al. (2012). Urethral injection therapy for urinary incontinence in women. Cochrane Database of Systematic Reviews (2).
  • Lipp A, et al. (2006). Mechanical devices for urinary incontinence in women. Cochrane Database of Systematic Reviews (7).
  • Naumann M, et al. (2008). Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1707–1714.
  • Shamliyan TA, et al. (2008). Systematic review: Randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Annals of Internal Medicine, 148(6): 1–15.
  • Sung VW, et al. (2007). Comparison of retropubic vs transobturator approach to midurethral slings: A systematic review. American Journal of Obstetrics and Gynecology, 197(1): 3–11.
  • Tanagho EA, et al. (2008). Urinary incontinence. In EA Tanagho, JW McAninch, eds., Smith's General Urology, 17th ed., pp. 473–489. New York: McGraw-Hill Medical.
  • Waetjen LE, et al. (2008). Factors associated with worsening and improving urinary incontinence across the menopausal transition. Obstetrics and Gynecology, 111(3): 667–677.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Avery L. Seifert, MD - Urology
Last Revised September 11, 2012

Last Revised: September 11, 2012

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